Written associated risks as long as you can

 Written by Nancy Lovering   If your Crohn’s treatment is not working as well as you’d hoped, your doctor may recommend trying biologics. These are drugs made from living cells that target the inflammation response. They are most often used for moderate to severe Crohn’s that isn’t responding well to conventional therapies.

   Like most medications, biologics have benefits and risks. They can reduce your inflammation and in doing so stall the progression of your Crohn’s, but they can also put you at risk for infections and certain cancers. Your doctor will help you weigh the risks and benefits to make an informed decision.  Some doctors advocate for trying biologics sooner than later in what is referred to as a “top-down” approach.

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The idea is to stop intestinal damage before it starts. Other practitioners recommend avoiding associated risks as long as you can and saving biologics for when other therapies aren’t working.  In either case, knowing a little of what to expect can make your switch to biologics easier.

  1. Biologics can’t be taken orally.  Your stomach acids will destroy the delicate complexity of this drug, so your biologic must be taken via injection or intravenously.  Injections are subcutaneous, which means the medication is deposited in the layer of fat between your skin and your muscle where it will slowly be absorbed. You can choose between receiving the training to do your own injections or having them done by a practitioner.  Intravenous doses are done in the form of an infusion in a clinical setting that can last several hours. Wear comfortable clothing, bring snacks and entertainment such as a book, and arrange to have a ride home afterwards.  2.

 Biologics can cause side effects.  Be prepared for some injection site changes including itching, redness, bruising, swelling or pain. You may also experience fever, chills, hives and headache.  3. Biologics have risks.  Biologics do come with risks. Depending on the specifics of your case, the potential benefits of biologic medicine may well outweigh those risks. Your doctor can discuss how the risks apply to you in order to help you make an informed decision.

  Infection –  your ability to fight infection is reduced Cancer – there is a small increase in your likelihood of developing lymphoma Liver function changes – your liver may be adversely impacted: notify your doctor immediately if you become jaundice Arthritis – you may develop joint pain Lupus-like reaction (LLR) – you may experience rash, fever, muscle ache and joint pain 4. Once you start biologics, it’s a good idea to keep taking them, even in remission.  If you stop taking biologics, they may not work as well when you start taking them again. This is because your body can build up anti-bodies that render the drug less effective. This is one of the reasons that doctors recommend continued biologic use even if your Crohn’s is in remission.

Another reason is that they are effective at maintaining remission by protecting you from reacting to flare triggers.  There are certain situations where your doctor will recommend taking a medication break, such as before surgery. For the most part though, expect your doctor to recommend consistent use of biologics.  5.

You should have all of your vaccinations before starting biologics.  Live vaccinations such as measles, mumps, rubella (MMR) are not recommended once you start biologics because of the risk of infection that this medication presents.  6. You’ll need to discuss pregnancy plans with your doctor.  Biologics are relatively new and because of this, the long-term effects on infants exposed during pregnancy isn’t fully known, although experts believe that the risk is low and conclude that the chance of fetal malformations while using biologics in pregnancy is close to that of the general population.  You and your doctor will need to discuss the risks of going off the medication during pregnancy vs the potential risk to your baby.

  Depending on the type of biologic you are using, it may be appropriate to take a medication break part way through your pregnancy. Babies exposed in utero to certain biologic medication may need to avoid live attenuated vaccines until they have passed the age of six months, and should be watched closely for signs of infection.  The Takeaway  Biologics are effective for suppressing the inflammation response that can trigger Crohn’s flares. They come with side effects including reduced ability to fight infection. They require a subcutaneous injection or intravenous infusion.

You should continue taking your biologic even while in remission. They work by targeting and suppressing the inflammation response.